Provider Demographics
NPI:1669097382
Name:STAR ED PLLC
Entity type:Organization
Organization Name:STAR ED PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SRIKANTH
Authorized Official - Middle Name:T
Authorized Official - Last Name:JYOTHINAGARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-376-9822
Mailing Address - Street 1:4617 SAINT CLAIR CT
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-1041
Mailing Address - Country:US
Mailing Address - Phone:248-275-1105
Mailing Address - Fax:
Practice Address - Street 1:4617 SAINT CLAIR CT
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-1041
Practice Address - Country:US
Practice Address - Phone:248-275-1105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty